The Department of Veterans Affairs has been under fire for years for its electronic health record VistA and the lack of interoperability with the Department of Defense’s EHR and other systems.

But while VistA may have its flaws, the VA and others insist that interoperability is not one of them.

“VA is a pioneer of interoperability,” said DSS Senior Health Informatics Consultant Deanne Clark. “VA continues to surge forward with interoperability with DoD, private sector and community care providers.”

A prime example? In 2009, the VA began data sharing with massive integrated health provider Kaiser Permanente -- which runs on Epic. The agency also works with hundreds of hospitals and thousands of clinics.

VA runs health exchanges through its Virtual Lifetime Electronic Record initiative, which encompasses the use of VA Exchange and Direct Messaging. Combined, the programs have partnered with about 250 healthcare organizations that connect with about 850 hospitals and thousands of clinic practices nationwide for about 1 million veterans.

Veterans can opt into the program, which connects their patient data to a long list of health providers like Walgreens, Mercy, University of Virginia Health System, INOVA Health System, Maine HealthInfoNet, Allina and Cedars-Sinai.

Vermont’s HIE is now connected to VA. And in New York, Rochester-based Canandaigua VA Medical Center has begun to share data with the Statewide Health Information Network for New York.

Possibly one of the greatest testaments to how ingrained VA is in the health community is its work with open source. VA established the Open Source EHR Record Alliance as a means to collaborate with other organizations. Much of VistA’s software has been in the public domain for years, and Vista-based products are available around the world.

“OSEHRA has been working with VA to come up with a standard VistA code,” said OSEHRA President and CEO Seong Mun. “Some of the standardized VistA has come into the private sector.”

Another new project is its Joint Legacy Viewer: a planned replacement for VistA Web. Clark explained it’s designed to further improve VA and DoD interoperability. In conjunction with the VA’s replacement, DoD is decommissioning its similar programs and replacing it with JLV.

Some 240,000 VA users have access to the program and more than 3 million records have been viewed through it as of early 2017.

“JLV should prove to Congress that VistA is capable of meeting interoperability requirements for data sharing with DoD and speak to the robust nature of the VistA platform,” Clark said.

For decades, the agencies attempted to connect, working together on an integrated EHR formerly known as iEHR that ultimately disbanded. What followed was finger pointing and Congressional chastisement.

Then, when the DoD announced it would update its unpopular and outdated EHR system with Cerner, the blame began to shift to VA for interoperability issues. But while Clark admitted that there are definite struggles between VA and DoD, “the balance today falls on the lack of DoD to share data with the VA.”

While Congress tends to compare the agencies, VA and DoD are staunchly different in size and function. DoD provides care for a less diverse population, is smaller and patients aren’t treated as long as they are within the VA. Further, many of the patients seen within the DoD end up at the VA, and there are differences in the types of services offered.

So what will it take for the DoD and VA to finally become interoperable?

“A unified vision and priorities for both agencies,” Clark said. “There’s been a lack of ability to sustain a constant direction with the influx of leaders and it affects the continuity of development over time.”

VA Secretary David Shulkin, MD shared similar views with the U.S. House of Representatives Committee on Appropriations on May 3:

“If there was an easy solution, I’m sure it would have been made already,” said Shulkin. “Congress has asked DoD and VA to work together for 10 to 15 years, and we’ve always found ways not to. [DoD Secretary] Mattis and I believe we need to find ways to work together.”